Dale Sanders is a leader in the area of applying data to improve outcomes across healthcare, however, he sees a potential to do this in a manner that may become a burden on healthcare practitioners. I always learn from Dale, hope you enjoy.
Bill Russell: 00:08 Welcome to this week in health it where we discuss the news information and emerging thought with leaders from across the health care industry. My name is Bill Russell. Recovering healthcare CIO and creator of this week in health it, a set of podcasts and videos dedicated to developing the next generation of health it leaders today, Walmart, epic and Cerner. New entrance into the market and our national approach to five g. In short. We’re going to, we’re going to look at the news this week. It’s something that we haven’t really been doing the last couple of weeks. I wanted to push as much into it as possible. This podcast is brought to you by health lyrics. Have a struggling healthcare project. You need to get, need to go well. Let’s talk visit health lyrics.com to schedule your free consultation. We have an exciting lineup over the next couple of weeks. Jonathan Manis, formerly with Sutter now with Christus health in Dallas, is going to be here next week.
Bill Russell: 00:56 Andrew Rosenberg is going to join us in a couple of weeks from University of Michigan Medical Center. Uh, Chad Brisendine and Saint Luke’s university health network. Charlie lohead, former CEO of explorers is now starting a blockchain company in healthcare. I’m looking forward to catching up with him. Uh, Eric Yablanka from Stanford Medical Center is also going to be here and uh, that is our next five weeks. It’s pretty loaded and a, there’s a couple people out there I just haven’t been able to get scheduled yet, but they have agreed to come on the show. So I’m really looking forward to uh, some, some great guests and great conversations. I really do appreciate each of them taking time out of their amazingly busy schedule to lend their voice to, uh, to this growing community. Uh, before we get to the news, my team, my team has encouraged me to share some of the things about the show and our program and our progress over the last year with you and some of our plans moving forward.
Bill Russell: 01:52 So we have a small team at this weekend. Health it, it’s a me, a part time production person, Justin and my consultant on the project from the beginning has been Jonathan Russell, my son, who has been gracious enough to share his thoughts on the show over the last 90 episodes. Uh, so if you don’t know it, here’s how the story goes. In in 2011, I was named Cio for Saint Joseph Health System, $7 billion health system, 16 hospitals in southern California. And when I came in, that was my first job in healthcare and I was struck by two things. And, uh, I mean, just the amount of change that was going on and the amount of change that was required, but probably the two biggest things that really struck me. So here’s some quick stories. You know, we moved to the cloud back in 2015 meaning we were in the process of closing down all of our data centers.
Bill Russell: 02:39 We move to a cloud data centers, uh, back in 2015 in the process, our operations team went from 35 people, uh, to only needing about five people in that. And that really drove home the need for me. Uh, I really understood at that point that need to retool many of the skills that exist within health. It, uh, the second story was one where, and it happened often where I’m sitting around the table with several CIO’s, uh, either at a conference or at an event and, and we’re discussing our challenges that we’re facing and how we’re, uh, doing certain things. And a CIO would share something. I would say, man, that that’s invaluable. I wish it could address my team and I would literally be writing things down and taking notes. And after one of those conversations, I just struck me and I was left wondering, I wonder what value there would be to just start recording those conversations and then sharing them with my staff.
Bill Russell: 03:33 And that was, um, I was really the genesis for the show. I thought, hey, you know what? I have this network of Cios, they’re all great friends and they’re all willing to, to share their, their successes because they believe in what we’re doing in healthcare. And, uh, it, it really has been amazing to me to just send out the invites, have all of them say, Hey, I want to be a part of this, uh, they come on the show. They take the time and we’d get to discuss these great topics. So when I left Saint Joseph Health Health, I started a consulting practice and, uh, but I still had that desire to sort of take that out. And when I started contacting these people, they said, yeah, I’ll do it. And so in January of 2018 we launched this week in health it, uh, really with a simple goal in that first year.
Bill Russell: 04:18 And that was a, to make sure we did one podcast per week for 52 weeks. And at the end of that year, we wanted to just see, okay, so what happened? And we, you know, we’ve now recorded over 90 episodes, produced over 400 videos. We’ve reached about 2,500 people a week with our show. Uh, we’ve discussed all sorts of technology topics, business topics, uh, shared many success stories, some failures. We’ve had over a 30 CIO’s on the show, a startup, CEOs, health system CEOs, former White House officials, and anyone who might bring value to the next generation of health. It leaders. Um, you know, throughout the life of the show, we’ve really had one sponsor from the beginning, which has been my consulting company, health lyrics. Uh, the show is done, you know, the show has really helped the company and the company has done extremely well. Um, and it, so it’s sort of a, a nice relationship between the two.
Bill Russell: 05:16 Uh, you know, the executive coaching of CEO’s has grown as a business, as, as the, uh, uh, the project work for the business as well. And in, so, you know, our goal for the first year was to build a following. And so as the story goes, the first episode I put out there and you know, you just, you put an episode out there, you send a couple emails, you put it out on social media, and the first week it had 28 listens. And you know, it’s good to commit to 52 weeks when you start. Because when that first show has 28 listens, you realize, wow, this is going to be a long, a long road. But it wasn’t that long of a road. It wasn’t long before we hit a hundred. Then we had two then we had 300, 400 and the first 500 and the first week.
Bill Russell: 05:58 Uh, and it just grew very rapidly, uh, because I think we hit a sweet spot talking to CIO’s, talking to CEOs about the news and the topics that matter. Uh, what really resonated and, uh, it started, started to grow. So, um, you know, that was our goal for the first year was to just do the 52 episodes and build a following. Our goal moving forward really is to build a community. So this is where you come in. If you have ideas for how we can do that, we want to hear from you. A email address for me is bill at this week in health It. com. Uh, that comes right to my inbox. Just send me a note. I’d love to read what you, uh, ideas you have, thoughts you have. If you want to see someone on the show or recommend someone to come on the show, please drop me a line.
Bill Russell: 06:40 If you have a story you want us to cover, please let me know. Uh, we’re going to explore, you know, how to do more live sessions this year. Even play around with some shows where we have more than two people on a see how that goes. Uh, we, we love experimenting and seeing, seeing how things go. We did some live things this year. Uh, some went great and some not as great, but you know, we’re learning as we go. Uh, what it takes to do, to do live shows. Um, but again, we’d love to hear from you. Please drop me a line, let me know what your thoughts are. If you know of any potential sponsors, please let us know that as well. We’re in conversations right now with some new sponsors and we hope to introduce them to you here shortly. So we love doing the show and plan to keep doing it for as long as you get value from it.
Bill Russell: 07:28 So, uh, hope, uh, hope that is a long time. So let’s, uh, let’s jump to the news. Let’s see what story and I’m going to, I’m just going to riff here. So, um, I, one of the stories I thought was the most interesting, uh, came from Beckers. Walmart has no shelf space for hospitals, with shotty healthcare and uh, Lisa Woods is their senior director of us healthcare at Walmart. And she talked about their centers of excellence program, which launched in 2013 and is available to 1.1 million people in Walmart’s medical plan. Uh, she recently coauthored a story in the Harvard Business Review on the topic. You can find that in the, uh, March, uh, March episode as well as a story on the, on the Becker’s site, uh, under the, uh, program that they launched, Walmart partners with top health systems that have demonstrated appropriate high quality care and outcomes for defined episodes of care such as joint replacements, spine, cardiac weight loss surgeries, um, current centers that accidents include Geisinger in Danville, PA, Cleveland Clinic, Johns Hopkins Systems in Baltimore among others.
Bill Russell: 08:32 And, uh, you know, one of the things she challenged this group was to say, go home and take down your billboards that have advertising that are advertising your er wait times. And you know, when, when you think about it, it makes perfect sense. You know, it’s, it, most of us would say it’s really inappropriate for every patient to seek care in a hospital emergency room. But yet we advertise, hey, if you need somebody, go, go here. Um, and, uh, and we just know that the emergency room is not, not nearly as good as going to a clinic and definitely not as good as going to a primary care physician. Uh, and she challenged them to take those signs down to which they have done all throughout a Arkansas as they’ve engaged their local community. Um, so they spend a lot of time on this, uh, on this topic of or on this subject of appropriate care.
Bill Russell: 09:24 I, and here’s a quote from her to us that means making sure our associates get the right diagnosis and the right treatment plan. Uh, she noted on Sunday then, then quality is how we ensure they go to the best doctors, the best health systems, and receive the best quality care available. So it’s an interesting model. They essentially have contracted with these entities and then when they’re, uh, when their patients, uh, when their employees have certain conditions, they send them to the centers of excellence. And the, she has shared a couple stories and it literally gets, I’ve seen one of these at the health conference last year and it will get a, literally gets audible gasps, you know, uh, consider associate true for CF diagnosis of cancer from their local medical providers of those who are approved by Mayo Clinic, which is Walmart Center of excellence for cancer to travel to Rochester, Minnesota for an evaluation.
Bill Russell: 10:16 More than 10% learn that they in fact do not have cancer. They receive a dif different diagnosis entirely. Well, 55% receive different treatment plans. Thinking about those numbers, 10% learned they don’t have cancer. 55% end up with a different treatment plant. So, um, you know, those are amazing numbers. Uh, here’s another, there are other staggering numbers from centers of excellence and conditions like 54% of Walmart associates who were told they need spine surgery locally only to visit to the center of excellence to learn that they could avoid surgery in their treatment. So, uh, you know, she shares those kinds of stories. So how do they do that? Yeah, it’s pretty interesting. So Ms. Woods or team gather massive amounts of publicly available data on health systems and it is publicly available. Uh, they actually, uh, uh, because they have so many employees, they distribute requests for information and conduct detailed onsite visits, which involve determining precisely which physicians do and don’t participate in the centers of excellence.
Bill Russell: 11:15 And so they’re collecting all this information. Plus they have detailed information of which physicians are doing a good job and which was physicians aren’t doing a good job as well as the public event, publicly available data on that as well. Walmart has also acquiring information about which healthcare providers in the United States have failed it’s associates with inappropriate care and misdiagnosis. So, um, she goes on to say, you know, what’s next? And she hints that some of the developments, uh, the first thing is the company is ramping up telehealth for their associates and it’s a huge patient satisfier as you would imagine. They’ve partnered with grand rounds. Uh, their copays for virtual visits, uh, have dropped from $40 to $4. Um, I mean, just that in and of itself would be a huge. And as we talk about the consumer in healthcare, this is a consumer play in healthcare and this is what future models look like.
Bill Russell: 12:11 So if health systems can start to figure out a way to replicate this with the clinically integrated networks and other things, which is very difficult, Walmart’s doing it. Uh, I think health systems are going to have to replicate it a next Walmart is running quality center networks in a, in radiology as well. And then the final thing she hinted at was, um, you know, they’re right now taking their associates that gets certain diagnosis and taking them out of those communities to places where they can get better care. And now they’re trying to figure out how to bring better care into the markets, into the communities where their, where their employees live. So, um, interesting model for consumer in healthcare. Great. Read from Beckers. Uh, also recommend the Harvard Business Review article. Next stuff. Epic Cerner. Continue to dominate the U S hospital EHR market. Uh, this is a class study.
Bill Russell: 13:05 Do I have the where did I get this article? Let me find where I got this article cause I have to give them a little bit of credit here. There is healthcare innovation. Okay. So healthcare innovation, uh, HC innovation group.com. So interesting article, I’m not even going to touch on this this much because everybody knows this. A large hospital systems, 500 beds or more epic has 58% market share, Cerner coming in second holding 27% market share. And uh, if for those of us keeping score at home, that is um, 85% market share of a large hospitals. Um, that’s interesting. And by the it talks about, you know, epic and Cerner and who’s growing and where they’re growing talks about Meditech, Meditech as well and some of the other players. Um, but here’s what I want to focus in on for this story and how it’s relevant for health systems.
Bill Russell: 14:04 Epic and Cerner will not be able to innovate. They will not be able to innovate because they’re too big. Whenever a mark, we saw this in the Erp market, uh, many years ago in other industries and we see this happen over and over again. When, uh, when individual providers of certain services get too big, they have too much market share, they have too many masters, they have too many things they have to do. They have to keep up with government regulations. They have to keep up with a custom bills. They have keep up with, uh, advancing the various platforms that they have four different things. They don’t have enough resources. They cannot possibly innovate. There is not enough resources for them to innovate once they get to a certain. Uh, and I actually read an article on this a while ago. I wish I could have found the article.
Bill Russell: 14:50 I couldn’t. Um, but essentially says when, uh, when four players get to 80% market share, uh, in a specific space, uh, all innovation stops, ceases. It’s, and it wasn’t even continues at a slow pace. It’s ceases. And so when you’re sitting across from epic and sitting across from Cerner and they say, we’re going to innovate, it’s not that they don’t have the intention to innovate, they just will not have the resources and the wherewithal to innovate. So why do I say that? Why does it, cause I’m a glass is half full kind of guy. But why do I take that approach? It is to say you’re going to have to find innovation outside of of those players and there’s a lot of places to find it. There’s still a rock health will tell you there’s still a ton of money being poured in. There’s a lot of big players that you could be having conversations with.
Bill Russell: 15:35 But I would be looking at innovative solutions outside of these players. Uh, for too long we’ve been saying, well, epic’s going to solve at Cerner is going to solve it. They solve a lot. They do a lot of very difficult heavy lifting things within the health system. Uh, but in terms of innovation, it is a, that is a huge warning sign. 85% market share between two players. Huge warning sign. I’m a willing to be proved wrong. If somebody wants to argue that point with me on the show, love to have that conversation. Bill at this week and health I t. com. Uh, drop me a line. We can discuss it. Um, let’s talk about five g a little bit. So five g is interesting to me. It’s interesting cause you know, we saw a rush, a rush rush, we saw a rush, a really go after this and talk about their deal with ATNT.
Bill Russell: 16:26 Well you know, if you’re in downtown Chicago and you’re one of the markets where five g is going to go live, yeah, you might as well sign a deal and partner with uh, one of the largest carriers and become a spot. They have to put up all these towers. They might as well start at your hospital and work their way out from there. Um, I have no problem with the signing of that deal and it makes perfect sense. On this one I’m going to strike a little different tone and it’s um, uh, first of all, five g is revolutionary. So five g is going to change a lot of things. Things we don’t even recognize and understand yet when you can download things a hundred times faster, when you can make those connections much more reliable, uh, when you can do way with last mile issues that you have with Iot and patient facing things.
Bill Russell: 17:13 Um, we did, uh, we actually developed some solutions that we put into patient’s homes and we had all sorts of problems. They would move the, uh, they would move the iPad to a different place and it would lose its wifi connection and, you know, so then we went to a three gene Four g and we had other issues with it as we moved. Five g has the ability to really drive that completely out of the market. And in fact, I think you’re gonna see a lot of, um, landline type things to the home go away and you’re going to have five g to the home. Uh, so five g is going to become the backbone for all communication across the country. Uh, backup obviously is going to be, um, hardwires so that you can, uh, uh, I mean it’s healthcare. You have to have a backup and it has to be a wireless is, is, is, uh, it’s going to be fraught with problems for obvious reasons.
Bill Russell: 18:04 So you’re going to want to have a backup, but this is going to create that backbone for healthcare to be delivered to the home and to extend your networks to places you hadn’t before and exciting new potential. So it is revolutionary. Three G to four g was nifty and evolutionary four g to five g changes the game. So I think the way to look at this again, I mean my, I’m really a CTO by trade and a CIO, uh, after it being a CTO. When I look at the evolution of technologies, I look at a four g, so I’ll go back and look at four g and three g four g is interesting came, uh, June, 2010, we saw Four g really be introduced into the US, uh, and let’s consider it fully deployed. Now I realize there are some really remote places that four g is not deployed today.
Bill Russell: 18:53 And uh, quite frankly, there’s some places on certain carriers that if you walk around very populated areas that g is not really well deployed. But at the end of the day we can you look at the maps for g covers the United States, a t and t, Verizon, sprint and t-mobile completely cover with four g, uh, just about everything except for the mountain tops. So I’m fully deployed by 2019. That’s a nine year span that you saw. Four g really get fully deployed. Okay. So here we are, August, 2018 five g is really first introduced into the market. You have a handful of markets, rate AT&t handful of markets, uh, t-mobile, handful of markets for Verizon. Uh, I think sprint has one or two as well. Um, so let’s just say we’re at the starting gate. Cities are starting to go live, uh, mostly major markets where they can make some money so they can make the money and then they can, uh, expand.
Bill Russell: 19:48 August 28. So when do you anticipate this being fully deployed? But took nine years for four g I anticipate because of the revolutionary nature of it, it’s going to go faster. And just because we’ve learned stuff from 20, uh, from Four g, uh, it should not take nine years, but it’ll probably still take about six years to get fully deployed. So you’re talking about, you know, uh, probably a four, a four year cycle to get into all the major markets. You’re talking about a, you know, a six year cycle to get into the secondary markets and to start to proliferate across rural markets. So if you’re worried about, oh, what are we going to do about five g, you might be worrying a little too early about this unless you’re in Chicago, La, Dallas, Charlotte, uh, you know, whatever the other markets are that are rolling it out tomorrow.
Bill Russell: 20:38 Um, you know, don’t get too worked up about it. You’ve got some time. I think it’s worth putting a plan together. I don’t think I’d be rolling too many things out, uh, that if you’re rolling out wireless, a Iot devices and those kinds of things without a five g plan, that is a mistake. And you’re going to want to consider what five g, uh, has store and make sure that’s on your roadmap. Uh, okay. So let’s go to this last story. Just, just find it fascinating for so many reasons. So at the, Oh, I gotta give credit here. Let’s see, where’s this from? Story is, oh, it’s a health evolution. It’s from the health evolution summit. There was a panel discussion and a health evolution news put out a story on it and it’s a how will new entrance drive market change insiders at Google and cvs health explained.
Bill Russell: 21:30 I’m just going to focus it on Google. David Feinberg, was there someone who I’d love to have on the show, um, and have tried to reach out to but have been unsuccessful at this point. I’d love to have this conversation directly with him. So David Feinberg was CEO at Geisinger, has left. He’s now vice president of Google health. And uh, he, uh, talked about AI and what AI can do. And anytime Google talks about this stuff, it just, it starts to blow your mind because you know, you see those, you see those memes out on the Internet where they say things like, you know, we think AI is, is, you know, machines sorta telling humans what to do. And that’s where it’s at. But the real state of where AI is at is it’s, it’s just picking out where’s Waldo and uh, you know, and it feels good about itself.
Bill Russell: 22:18 That’s the meme. But the reality is Google’s doing a lot more than that. They just in typical Google fashion, haven’t figured out how to take it to market yet. So let me just read some of this stuff at the leading edge of tech Feinberg walked listeners through familiar Google search all the way to an AI algorithm that noticed undiscovered differences between male and female retinas. Uh, currently Google users search for answers to health questions a billion times a day, 1 billion times a day. They’re hitting Google for health, uh, answers. So just sort of digest that a little bit when you’re putting together your consumer plans because they are not searching the local health system website at this point or any local health system, a application that you have put out there. So, but they are searching Google. So it’s something to, something to consider. But with just a little bit more information, Feinberg says the, those results could easily be refined to exactly what the searcher needs.
Bill Russell: 23:18 For example, if you typed in bloating and there were a couple of choices, male or female, are you talking about yourself? Are you pregnant? Is there an elderly person or is it an elderly person or a baby? With just a few pieces of information, we could, uh, collate the results better for you. The next refinement of that approach might with proper consent tied to the user’s health history for further customized research that refinement could also help clinicians understand their patients’ concerns. Feinberg noted, I had patients come in with the whole internet or they had searched enough to find the answer they wanted that bee pollen would cure their schizophrenia. Um, I guess we all fundamentally know this. This is not rocket science to us. Most people start their journey for information and knowledge with Google. All right? So if that’s where they’re starting, I would say every health system in the country needs to figure out how to have a relationship and a partnership with Google.
Bill Russell: 24:14 I’m not sure what that looks like, but it would just strike me as it would make sense to be having those conversations. And if you’re not having those conversations, there’s a chance you’re gonna be left behind a billion searches a day around, uh, you know, a billion times a day, which is just mind blowing, uh, that people are searching Google for health information. So, Eh, and you almost have to look at it from a pragmatic standpoint. Are you going to be able to build a search engine where people go, Hey, I trust I trust the health system more than I trust Google. Therefore I’m going to start there for health. And I’ve heard a lot of health organizations say, well, that’s what we’re going to do. We’re going to put this sort of thing together and they should, but pragmatically to get to get mind share and market share on that, it’s going to take a significant marketing effort.
Bill Russell: 25:08 Um, you know, he goes on to say some other interests. I think a Google search, uh, has so many data sources. It also has access to more data than the CDC. Uh, or your local public health department Feinberg says, we can tell you who has Lyme disease with accuracy, that’s as high as the CDC. Uh, but, but it’s two years earlier. Google can identify restaurants associated with cases of food poisoning with about 85% accuracy. Now we’ve got to figure out how to do those things and not be creepy. Well, that’s a good idea. Um, they have the algorithms, they have a lot of data and they have a ton of data sources. I can’t think of a better partner for, uh, things like social determinants of health and population health and uh, and Ai. I mean, obviously there’s other partners. Microsoft’s a good partner and a Amazon’s good partner.
Bill Russell: 26:01 Um, heck they, I mean the Ehr vendors are decent partners, but they don’t have the access to the kinds of data that Google has access to. And quite frankly, uh, you know, Google and Amazon are even not on par with each other. Amazon has a lot of consumer facing data and they have the computing resources. I think you have to look at each cloud player that’s out there and determine what they are good at. So this is, this is turning into more of a consulting session then a report on the news. But um, it’s just really interesting to me as you, as you look at this to see the kind of things that Google could do with their algorithms and the reach that they have with their search. They’re ubiquitous search that is available to, um, to everyone who’s looking for health answers across the, across the globe really.
Bill Russell: 26:50 So a really powerful story, David Feinberg. Uh, I think it’s going to be doing some great work. Who knows? Google has always struggled to commercialize anything that they do. So they will be slid a market. And if people want to bash Google and say they’ll never do anything in healthcare, that’s potentially a valid point because they have struggled, uh, in so many areas where people have just lapped them. Um, but, uh, you know, from a patient standpoint, I hope that’s not the case this time. So, so, uh, you know, that’s, that’s probably enough news for today. Um, this shows production of this week in health it for more great content. You could check out our website at this week in health it.com or the youtube channel @thisweekinhealthit.com/video. Thanks for listening. That’s all for now.
Dale Sanders is a leader in the area of applying data to improve outcomes across healthcare, however, he sees a potential to do this in a manner that may become a burden on healthcare practitioners. I always learn from Dale, hope you enjoy.
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